Medgic.pk - Hairloss

We'll be asking a few questions so your doctor can find the best treatment for you. This quiz is short and sweet, and confidential between you and your doctor.

Please make sure your email address is correct

Please provide your valid phone number.

By providing your phone number, you are giving us permission to reach you through SMS or WhatsApp.

Which image best illustrates your pattern of hair loss?

regular hair loss & dandruff

mild hair receding

Medium hair receding

thinning of hair crown

hair thinning & receding

center baldness

What results are you looking for?

Regrow my hair

Prevent further hair loss

Regrowth and prevention

Is there hair loss in the family?

No Yes

When did you first notice hair loss?

I haven't. I'm in prevention mode Recently It's been gradually happening for years It's been falling out in patches I've lost 50% in the last three months

Have you ever treated hair loss before? Including any doctor or supplements

Yes Kind of. I've dabbled. No

What treatments have you tried in the past?

Did you see any results?

Did you experience any side effects from the treatment?

Please note the name of the treatment, dosages and effectiveness.

Have you ever seen a doctor or specialist for hair loss?

No Yes

Please provide the doctor with more information. Were there any pathology tests, referrals to a specialist, correspondence from another health professional or any other investigations made into your condition?

Are you allergic to any medication? Do you have any other allergies?

No Yes

Please list what you are allergic to and the reaction that each one causes.

Are you currently taking any medications, supplements or hormone therapy (including anything for hair loss)?

No Yes

What medications, supplements, herbs, and/or home remedies did you use?

Have you now or in the past ever suffered or been treated for any other medical conditions?

No Yes

Please describe what medical conditions you have suffered in the past or are facing currently

To help guide your doctor, what matters more to you in a hair loss treatment routine?

Convenience Effectiveness I don't know

Send your doctor a photo (or do it later). This will help find the right treatment for your hair.

Yes, I'm ready now Not a good time

Let's upload a photo of the front.

Please pull your hair back so your hairline is visible.

Upload Image

Next, let's see the crown of your head

Upload Image

Have you in the past, or do you currently suffer from any mental disorders?

Stress Depression Anxiety Bipolar Psychotic Disorder Other none

Are you experiencing any other symptoms

e.g dandruff, fungal infection, psoriasis, severe stress, rapid weight loss, hair-pulling, autoimmune conditions

No Yes

Please list any other symptoms you have experienced & how long you have been experiencing them?

Are you a.....

Male Female

What is your date of birth?

/ /

How tall are you? in Inches.

How much do you weigh? In kilograms.

How often do you exercise?

Once a week 2-3 time per week 3-5 times a week Not a priority

How would you rate your average nights sleep?

8-12 hours 6-8 hours 3-6 hours Or less Disrupted sleeping pattern

Do you want to provide additional details that can help your doctor understand you better

No Yes

Did you see any results?

Did you experience any side effects from the treatment?

Information

Payment Information